Can Doctors Be Happy? Part 1

11/06/2014

I don’t think I know any doctors who are happy in their work.

Time magazine tells us that 44 percent of physicians say they are “very happy,” a significant difference from the 67 percent of clergy who say they are happy. Doctors are right down there with lawyers, accountants, and dentists. But I have a hard time believing that 44 percent anyway. I’m a psychologist, and I know a lot of doctors, many of whom are making plans to leave the profession ASAP.

Some of this is a reflection of world-wide trends. Though physicians generally make a decent income, in the last few years there’s been an increasing recognition — and good research evidence — that advances in personal prosperity may actually lead to unhappiness. In fact, in the United States and Europe, over the fifty years since scientists started measuring personal happiness reliably, people report that they are less and less happy every year, although personal wealth continues to increase. As other nations become more Westernized, and prosperity spreads around the globe, happiness declines as well. At the same time, psychology has for the first time begun to look into what really does make us happy. Unfortunately for physicians, the news is not all good. There’s a lot that accompanies the medical profession that science can now prove will add unnecessary misery; but now we’re beginning to understand what we can do about that.

You have to start with the recognition that happiness isn’t normal — humans aren’t naturally wired for it. We can get happy when good things happen, but it’s very difficult to maintain that feeling. Humans are wired to be able to feel good when good things happen, but the feeling never lasts. That process is in our brains where our genetic heritage put it. The cavemen who liked to linger contentedly around the fire were more likely to get eaten by the bears, and thus were not available to be our ancestors. Instead, those who survived to be our ancestors were alert, competitive, never satisfied, always on the move — and we’ve got their genes.

Bottom line: Your brain really doesn’t care whether you’re happy or not, as long as you survive. Doctors tend to have a surfeit of those competitive, hard-driving, perfectionistic genes, and that places them at a special disadvantage.

The Hedonic Treadmill

Then there’s what some call the Hedonic Treadmill. The greatest myth of human life is the belief that I’ll be happy if I just get what I want. All the research shows that as soon as we get what we want, we’ll just want something else — but we seem doomed to keep forgetting this. This is another evolutionary gotcha; our brains trick us into doing what’s good for species survival by making us believe it will make us happy. The things we crave — money, power, success, beauty — in the old days would have put us in a better position to pass on our genes; in fact, they still do a little. They don’t make us any happier, but we have real trouble learning that, because our genetic heritage, expressed in the unconscious, is so powerful. How do you manage to stay happy with a brain like this?

Staying happy is also more of a problem these days because our society has broken up our most of our means of security — meaningful work, close-knit families, a supportive community, a sense of religious belonging. It’s replaced them with more of the same fruitless values we just discussed (money, power, etc.) but at the same time made those things harder to reach. Despite the growth in overall wealth, most Americans today are working 25 percent more hours than they were 25 years ago simply to stay in place economically. Hard to be happy if you’re only treading water with no land in sight.

Vulnerabilities to Happiness

Doctors may have gone into the profession with higher values — to be of service, to be part of a respected community — but medical school debt and the need to squeeze in eight or ten patients an hour will erode those values pretty quickly. Your idealism has no place to go, and you become kind of cynical. You begin to feel that you’re working for Big Insurance while being manipulated by Big Pharma and scrutinized by Big Brother, and you lose the autonomy that used to go with the practice of medicine.

Doctors have other vulnerabilities to unhappiness. They tend to be pessimists — they’re trained to look for every little thing that might go wrong with patients — while happy people tend to be optimists. Optimists tend to believe that people are basically good, while doctors come in contact daily with some of mankind’s least attractive qualities.

Happy people get by on some protective illusions. In one experiment where subjects were told to play a video game (but their game controller did not actually affect the action on tte screen), optimistic people went on playing happily for some time, while pessimists would soon turn to the experimenter and complain that the joystick is broken. It’s a more realistic, but less happy, way of life.

Doctors are trained in critical and objective thinking. Happy people tend to overrate their own performance in virtually anything they try, while doctors turn all that critical thinking on themselves. Doctors tend to be perfectionists, a major obstacle to happiness.

There’s also the overwork and isolation that goes with the profession. Managed care has made it so that you have to zip through your patients so that you only have a little time to spend with them. You don’t get to interact with them as people, and perhaps the quality of your work suffers. We know that autonomy, control, and pride in your work are essential to satisfaction in any career — and doctors are losing the battle on all three fronts. You get used to making snap judgments — and if you carry that tendency over to your family and friends you’ll be missing out on the richness of life.

Yet there is good news for physicians in the latest research about happiness: We can change our own brains. You may be constitutionally a pessimist and your professional experience may have made you isolated and cold, but you can change. The new neuroscience is teaching us very concrete methods we can use to overcome our genetic heritage and the bad mental habits we’ve developed. We can do a great deal to make us more receptive to happiness, but it takes longer than we want it to.

Some researchers recently taught a group of college students to juggle and, using the latest high-tech neuroimaging equipment, observed their brains as they learned. After three months of daily practice the researchers could identify measurable growth in gray matter in certain areas of their subjects’ brains; after three months of no practice the growth disappeared. Life experience changes the structure of the brain itself. Just like juggling, happiness is a set of skills you can learn; and, just like juggling, learning to be happy is work that requires dedication and practice.

We know now that the ways of acting, thinking, feeling, and relating that lead to lasting happiness do not come naturally to most people. It takes conscious, sustained effort to overcome the habits that keep us unhappy and learn new habits to replace them. But after you’ve done that work, actually being happy is not much work at all. Once you’ve learned to ride a bicycle, or type, or juggle, or acquired some of the happiness skills we’re going to talk about, it doesn’t take much conscious effort to maintain your ability. If you practice regularly, your brain will incorporate your new skills so that it gets to be easier and easier to be happy. Three months is longer than we want to stick to any reform plan; but if you appreciate that your brain is changing a little every day, it may be easier to maintain your commitment.

In Part 2, we’ll review three specific skills to practice to raise your happiness level: reducing unnecessary misery by learning mindfulness, experiencing more joy, and finding greater life satisfaction through strategic goal setting.

Richard O’Connor, MSW, Ph.D., is a psychotherapist in private practice in Connecticut and Manhattan and is the author of four books, the latest just published. Entitled Happy at Last: The Thinking Person’s Guide to Finding Joy(St. Martin’s), the book reviews why it is so difficult to find happiness despite material wealth, and guides the reader with a clear roadmap toward solutions for these problems, grounded in the latest scientific research.